Tuesday, September 6, 2011

Putting the "Gee" in Gynecological Exams

As the title suggests, this topic will be about lady parts. If you are at all squeamish or sensitive to this subject STOP READING NOW.

*Plays a soothing violin concerto for those leaving, and sends you off to your happy places.**

Okay we're back. So I'm guessing that the rest of you have either seen it, want to see it, or are okay with talking about it. ;)

About a year ago my doctor's office declined to renew my prescription for the happy pills that keep me sane, mainly because I hadn't been in to see my doctor for over a year. Relatively understandable, but it would have been a little nicer to have some sort of heads up rather than the immediacy of "Hey, you're out of pills and we're holding your already tenuous sanity hostage until you come in and have a full physical." Especially since the clinic had specifically made a point of assigning Mr. Eggshells and I doctors so we'd have these kind of reminders. (Actually, to be precise, the clinic had a hissy fit and *made* us pick doctors. So that we'd have primary physicians who would be up to date on all our stuff. Then set it up so we'd have different doctors. I'm still not sure, years later, how this was of any benefit to us.)

Nevertheless, I agreed to come in if they agreed to give me an interim prescription to keep me going (because withdrawal is a bigger bitch than I could ever hope to be!). Turns out that my doctor had left the practice almost a year before (ah, now I see how it benefits me to have a single doctor...not) and that I would need to see someone new. It was also time for my annual exam, so it was decided that we'd do the meet 'n greet at the same time, a kind of "get to know you" from the uterus on up.

Now for those of you enlightened and fearless males in the audience who hung in there despite the subject matter, there are just a few things to know about the average gynecological exam. The exam itself generally includes an external visual exam, a bimanual exam (checking the uterus and ovaries), and a speculum exam (using a speculum tool to open the vaginal walls and finally, a Pap smear of cells from the cervix is taken with a swab to be tested for cervical cancer. There may also be a breast examination.

Surprisingly, the annual isn't the highlight of most women's day either. While it's not particularly painful, it's awkward and uncomfortable. And unless a woman is used to hopping up on a table and getting into the stirrups to expose her nethers to all, it's also a little on the vulnerable-making. (Plus, unlike similar scenarios, there are no dollar bills being tucked into your panties while you're on display...)

But that's okay because these are doctors and nurses, medical professionals who have seen it all. They're there to perform a very necessary service in preventative health care. At least that's what we tell ourselves when convincing ourselves to keep that yearly appointment.

Now this was not my first exam by any means, but far back in my history lurks the spectre of that initial exam so many thousands of years ago. That doctor, who for all intents and purposes looked like a female, I'm fairly certain was really a hybrid shifter of Lovecraftian ilk. Details not required, but the upshot of the whole thing was that it did not go well. At all. For either of us.

Needless to say, between that experience, a subsequent one where a doctor actually told me to relax because it was just like sex (um, WHAT?!), and my generalized anxiety, that these exams are a bit of a minefield for me. Staying centered, breathing through the stress, and communicating with the medical staff are key things for me to do to make it a relatively tolerable experience for all of us.

Because two things will happen if it's not...my pelvic muscles will shut down and that is the end of the exam, and my kick reflex will work quickly. Not necessarily in that order. (Oddly enough, doctors are very interested in not getting kicked in the face during an exam...who would have thought?)

Back to last year...with my new doctor. Who is, coincidentally a NEW doctor. Fortunately he's a new doctor with a sense of humor. Unfortunately he's a new doctor with a sense of humor like my husband's. For those of you privileged to know Mr. Eggshells, you will know that one of the kinder ways to describe it is "odd". What's awesomely horrific in a husband is not necessarily so in a doctor. A doctor with a speculum.

The clinic building dates back to the 1940's or 1950's. I'm not sure who designed the interior offices, but I do know that they have not thought out the entire position of the examination table or the potential ramifications of certain types of examinations on said table. I can only surmise that at one point either tables were smaller, or people were all midgets. I cannot think of any other reason why they would set a room up so that the doctor basically has put his head in a sink to do an exam.

So here we all are, the sink, the badly-positioned bed, the new doctor, the nurse, and me in the stirrups. And I forgot the most crucial part of the process - letting my new doctor know that he needed to use the smaller speculum. (Yes, likely TMI, but there is a point to telling you this and not just cuz I can! :P)

After a couple of misses with the larger speculum, I remembered...funny how blunt force trauma and searing vaginal pain can bring you back to what's really important. We then commenced the gymnastics of the "speculum swap" to be able to actually finish the exam.

Now new doctor, while feeling completely HORRIBLE for the misses, has also flipped into what I can only assume is his safe place when stressed...humor. Which is also, fortunately, my safe place. He starts cracking one-liners at me. I tell him about the urban legend about the older woman at her annual exam. We're now completely busting a gut and the nurse...well the nurse was not impressed with either of us. Seems she left her sense of humor at the door.

Then it was time for the breast exam...so it was time for round two of awkward, since the exam table was a mere inches from the wall. To be able to examine my left side, he had to wedge himself into the few inches of space against the wall. Still cracking jokes, by the time he told me he'd just have to climb on top of me to do the breast exam, I was hysterical with laughter.

Exam finally over, they left me to get dressed and when the doctor returned, he introduced himself as if we'd never met and we started over.

Two weeks later I was at my follow up and Mr. Eggshells was with me for his initial. The doctor introduced himself, and with a completely straight face, Mr. Eggshells told him that for his examination he'd be needing the small speculum as well. ;)